gms | German Medical Science

7th EFSMA – European Congress of Sports Medicine, 3rd Central European Congress of Physical Medicine and Rehabilitation, Annual Assembly of the German and the Austrian Society of Physical Medicine and Rehabilitation

Outline

Objective: To retrospectively examine the clinical results of conservative treatment compared to arthroscopic treatment of meniscal tears, in two different populations: athletic and non-athletic.

Material/Methods: All patients presented with meniscal tears documented by both clinical and imaging studies and were divided in two groups. Group A included 58 patients who were regularly involved in athletic activities, with a mean age of 24 (13–38) years. Group B included 80 patients who were not involved in athletic activities, with a mean age of 54 (16–72) years. Meniscal injuries suggested as an acute injury in 47 patients (81%) of group A and in 22 patients (27.5%) of group B. Independently of the kind of the treatment received all patients in both groups underwent the same physiothepeutic protocol of a mean duration of 4 (3–6) weeks before the final treatment decision. Patients of group A were subdivided in two subgroups: Group Aa included 49 patients (84.5%) who received arthroscopic partial meniscectomy (medial in 40 patients and lateral in 9 patients); group Ab included 9 patients (15.5%) who only received a conservative rehabilitation protocol. Patients of group B were also subdivided in two subgroups: Group Ba included patients 32 patients (40%) who received arthroscopic partial meniscectomy (medial in 27 patients and lateral in 5 patients); group Bb included 48 patients (60%) who only received conservative treatment with the same rehabilitation protocol. The Tegner Activity Level Scale, the Lysholm Knee Scoring Scale and the IKDC Subjective Knee Evaluation score were used to evaluate the final outcome in each population subgroup. The mean follow-up was 32 (19–58) months for group Aa, 39 (22–60) months for group Ab, 31 (18–54) months for group Ba and 30 (18-54) months for group Bb.

Results: In subgroup Aa the mean values were 95 for Lysholm score, 9.65 for Tegner score, and 95.15 for IKDC score. In subgroup Ab the mean values were 83.44 for Lysholm score, 8.33 for Tegner score, and 80.98 for IKDC score. In subgroup Ba the mean values were 80.2 for Lysholm score, 3.86 for Tegner score, and 51.16 for IKDC score. In subgroup Bb the mean values were 79.71 for Lysholm score, 4.25 for Tegner score, and 49.97 for IKDC score.

Conclusion: Arthroscopic partial meniscectomy followed by a supervised rehabilitation program showed superior results compared to a rehabilitation program alone in the athletic population. Although the number of patients in the two subgroups are not comparable for statistical analysis, the superior results of arthroscopic treatment was expected considering the mainly traumatic event of this young aged and high demanding population. On the other hand, knee scoring scales did not detect any significant difference between patients of subgroup Ba who received arthroscopic partial meniscectomy supplemented with a rehabilitation protocol compared to patients of subgroup Bb who treated with a rehabilitation program alone. The results might suggest that in middle-aged patients with degenerative meniscal tears we should probably insist to physiotherapy, strengthening and rehabilitation regimens before proceed to arthroscopic meniscectomy.